脑白质高信号严重程度与络病学证型分布研究  

Correlating white matter hyperintensities severity with collateral disease syndrome type distribution

作　　者：占剑虎 邱伟文 蓝海源 王华强 ZHAN Jianhu;QIU Weiwen;LAN Haiyuan;WANG Huaqiang(The Third Clinical Medical College of Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang China;Department of Neurology,Lishui TCM Hospital Affiliated to Zhejiang Chinese Medical University,Lishui 323000,Zhejiang China;Department of Radiology,Lishui TCM Hospital Affiliated to Zhejiang Chinese Medical University,Lishui 323000,Zhejiang China)

机构地区：[1]浙江中医药大学第三临床医学院,浙江杭州310053 [2]浙江中医药大学附属丽水中医院神经内科,浙江丽水323000 [3]浙江中医药大学附属丽水中医院放射科,浙江丽水323000

出　　处：《中国现代医生》2025年第2期1-4,共4页China Modern Doctor

基　　金：国家中医药管理局科技司-浙江省中医药管理局共建科技计划项目(重点项目)(GZY-ZJ-KJ-23097);浙江省自然科学基金项目(LBY22H280001)。

摘　　要：目的探讨脑白质高信号(white matter hyperintensities,WMH)严重程度与络病学证型的分布关系情况。方法选取2022年12月至2023年12月在浙江中医药大学附属丽水中医院住院及门诊明确诊断为脑小血管病的患者208例作为研究对象。所有入组研究对象均完成络病学辨证分型,在磁共振液体衰减反转恢复序列图像上对WMH进行Fazekas评分及体积的测量。结果在208例患者中,脑络失荣型52例,Fazekas评分为3(2,3)分,WMH体积为(8.80±9.37)ml;脑络瘀阻型67例,Fazekas评分为4(3,4)分,WMH体积为(13.42±9.18)ml;脑络绌急型47例,Fazekas评分为4(3,5)分,WMH体积为(14.60±10.07)ml;脑络瘀塞型42例,Fazekas评分为4(4,5)分,WMH体积为(18.65±10.71)ml。其中Fazekas评分为1~2分的患者55例以脑络失荣最为常见,3~4分有105例以脑络瘀阻型最为常见,5~6分有48例为以脑络瘀塞型最为常见。脑络失荣型、脑络瘀塞型与其他证型间在Fazekas评分、WMH体积方面的差异有统计学意义(P<0.05)。结论WMH严重程度与络病证型分布具有一定的对应关系,且可作为评估络病患者病情严重程度的参考指标。Objective To explore the relationship between the severity of white matter hyperintensities(WMH)and the distribution of collateral disease syndrome types.Methods A total of 208 patients clearly diagnosed with cerebral small vessel disease in Lishui TCM Hospital Affiliated to Zhejiang Chinese Medical University from December 2022 to December 2023 were selected as the study subjects.All enrolled subjects in the study completed the collateral disease syndrome differentiation.WMH was graded on magnetic resonance imaging fluid-attenuated inversion recovery(FLAIR)sequences using the Fazekas scale and measured for volume.Results Among the 208 patients,there were 52 cases of the brain collateral impoverishment(BCI)type,with Fazekas score of 3(2,3)points,and WMH volume of(8.80±9.37)ml;67 cases of the brain collateral stasis(BCS)type,with Fazekas score of 4(3,4)points,and WMH volume of(13.42±9.18)ml;47 cases of the brain collateral constraint(BCC)type,with Fazekas score of 4(3,5)points,and WMH volume of(14.60±10.07)ml;and 42 cases of the brain collateral occlusion(BCO)type,with Fazekas score of 4(4,5)points,and WMH volume of(18.65±10.71)ml.Of these,55 patients with a Fazekas score of 1-2 points were most commonly of the BCI type,105 patients with a Fazekas score of 3-4 points were most commonly of the BCS type,and 48 patients with a Fazekas score of 5-6 points were most commonly of the BCO type.There were statistically significant differences in Fazekas scores and WMH volumes between the BCI and BCO types and other syndrome types(P<0.05).Conclusion The severity of WMH corresponds to a certain distribution of collateral disease syndrome types,and can serve as a reference indicator for assessing the severity of illness in patients with collateral disease.

关 键 词：络病学 辨证分型 脑白质高信号 脑小血管病 

分 类 号：R743[医药卫生—神经病学与精神病学] R224[医药卫生—临床医学]